{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:02:34Z","timestamp":1793638954724,"version":"4.5.1"},"reference-count":79,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Post-COVID syndrome is increasingly recognized as a new clinical entity in the context of SARS-CoV-2 infection. Symptoms persisting for more than three weeks after the diagnosis of COVID-19 characterize the post-COVID syndrome. Its incidence ranges from 10% to 35%, however, rates as high as 85% have been reported among patients with a history of hospitalization. Currently, there is no consensus on the classification of post-COVID syndrome. We reviewed the published information on post-COVID syndrome, putting emphasis on its pathogenesis. The pathogenesis of post-COVID syndrome is multi-factorial and more than one mechanism may be implicated in several clinical manifestations. Prolonged inflammation has a key role in its pathogenesis and may account for some neurological complications, cognitive dysfunction, and several other symptoms. A multisystem inflammatory syndrome in adults (MIS-A) of all ages has been also described recently, similarly to multisystem inflammatory syndrome in children (MIS-C). The post-infectious inflammatory pathogenetic mechanism of MIS-A is supported by the fact that its diagnosis is established through serology in up to one third of cases. Other pathogenetic mechanisms that are implicated in post-COVID syndrome include immune-mediated vascular dysfunction, thromboembolism, and nervous system dysfunction. Although the current data are indicating that the overwhelming majority of patients with post-COVID syndrome have a good prognosis, registries to actively follow them are needed in order to define the full clinical spectrum and its long-term outcome. A consensus-based classification of post-COVID syndrome is essential to guide clinical, diagnostic, and therapeutic management. Further research is also imperative to elucidate the pathogenesis of post-COVID syndrome.<\/jats:p>","DOI":"10.3390\/vaccines9050497","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T22:46:14Z","timestamp":1620859574000},"page":"497","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":171,"title":["Post-COVID Syndrome: An Insight on Its Pathogenesis"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0264-3547","authenticated-orcid":false,"given":"Helena C.","family":"Maltezou","sequence":"first","affiliation":[{"name":"Directorate of Research, Studies and Documentation, National Public Health Organization, 11523 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Androula","family":"Pavli","sequence":"additional","affiliation":[{"name":"Department of Travel Medicine, National Public Health Organization, 11523 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-4715","authenticated-orcid":false,"given":"Athanasios","family":"Tsakris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021, May 07). Coronavirus Disease (COVID-19) Situation Reports. Available online: https:\/\/www.who.int\/emergencies\/situation-reports."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101791","DOI":"10.1016\/j.tmaid.2020.101791","article-title":"Outcomes of 3737 COVID-19 patients treated with hydroxychloroquine\/azithromycin and other regimens in Marseille, France: A retrospective analysis","volume":"36","author":"Lagier","year":"2020","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"m4529","DOI":"10.1136\/bmj.m4529","article-title":"Clinical spectrum of coronavirus disease 2019 in Iceland: Population based cohort study","volume":"371","author":"Eythorsson","year":"2020","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1093\/infdis\/jiaa804","article-title":"Association between upper respiratory tract viral load, comorbidities, disease severity, and outcome of patients with SARS-CoV-2 infection","volume":"223","author":"Maltezou","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pavli, A., Theodoridou, M., and Maltezou, H.C. (2021). Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch. Med. Res.","DOI":"10.1016\/j.arcmed.2021.03.010"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Havervall, S., Rosell, A., Phillipson, M., Mangsbo, S.M., Nilsson, P., Hober, S., and Thelin, C. (2021). Symptoms and functional impairment assessed 8 months after mild COVID-19 among health care workers. JAMA.","DOI":"10.1001\/jama.2021.5612"},{"key":"ref_7","unstructured":"Patient-Led Research Collaborative (2021, May 07). Report: What Does COVID-19 Recovery Actually Look Like? An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team. Available online: https:\/\/patientresearchcovid19.com\/research\/report-1\/."},{"key":"ref_8","unstructured":"Writing Committee for the COMEBAC Study Group, Morin, L., Savale, L., Pham, T., Colle, R., Figueiredo, S., Harrois, A., Gasnier, M., Lecoq, A.L., and Meyrignac, O. (2021). Four-month clinical status of cohort of patients after hospitalization for COVID-19. JAMA."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100173","DOI":"10.1016\/j.bbih.2020.100173","article-title":"Cytokine storm induced new onset depression in patients with COVID-19. A new look into the association between depression and cytokines\u2014Two case reports","volume":"9","author":"Alpert","year":"2020","journal-title":"Brain Behav. Immun. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00408-020-00406-6","article-title":"Is there (will there be) a post-COVID-19 chronic cough?","volume":"198","author":"Dicpinigaitis","year":"2020","journal-title":"Lung"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e238419","DOI":"10.1136\/bcr-2020-238419","article-title":"Sudden irreversible hearing loss post COVID-19","volume":"13","author":"Koumpa","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Sun, B., Tang, N., Peluso, M.J., Iyer, N.S., Torres, L., Donatelli, J.L., Munter, S.E., Nixon, C.C., Rutishauser, R.L., and Rodriguez-Barraquer, I. (2021). Characterization and biomarker analyses ofpost-COVID-19 complications and neurological manifestations. Cells, 10.","DOI":"10.3390\/cells10020386"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1001\/jama.2020.12839","article-title":"Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review","volume":"324","author":"Wiersinga","year":"2020","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"m3026","DOI":"10.1136\/bmj.m3026","article-title":"Management of post-acute COVID-19 in primary care","volume":"370","author":"Greenhalgh","year":"2020","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"993","DOI":"10.15585\/mmwr.mm6930e1","article-title":"Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network-United States, March\u2013June 2020","volume":"69","author":"Tenforde","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_16","unstructured":"(2021, May 07). Covid-19-Long-Term-Health-Effects, Available online: https:\/\/www.gov.uk\/government\/publications\/covid-19-long-term-health-effects\/covid-19-long-term-health-effects."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.cmi.2020.09.052","article-title":"Follow-up of adults with noncritical COVID-19 two months after symptom onset","volume":"27","author":"Laurent","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Becker, R.C. (2021). COVID-19 and its sequelae: A platform for optimal patient care, discovery and training. J. Thromb. Thrombolysis, 1\u20138.","DOI":"10.1007\/s11239-021-02375-w"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1038\/s41591-021-01283-z","article-title":"Post-acute COVID syndrome","volume":"27","author":"Nalbandian","year":"2021","journal-title":"Nat. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e220","DOI":"10.5001\/omj.2021.91","article-title":"The post-acute COVID-19 syndrome (long COVID)","volume":"36","year":"2021","journal-title":"Oman Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Scordo, K.A., Richmond, M.M., and Munro, N. (2021). Post-COVID-19 syndrome: Theoretical basis, identification, and management. AACN Adv. Crit. Care, e1\u2013e8.","DOI":"10.4037\/aacnacc2021492"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Amenta, E.M., Spallone, A., Rodriguez-Barradas, M.C., El Sahly, H.M., Atmar, R.L., and Kulkarni, P.A. (2020). Post-acute COVID-19: An overview and approach to classification. Open Forum Infect. Dis., Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7665635\/.","DOI":"10.1093\/ofid\/ofaa509"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fernandez-de-Las-Penas, C., Palacios-Cena, D., Gomez-Mayordomo, V., Cuadrado, M.L., and Florencio, L.L. (2021). Defining post-COVID symptoms (post-acute COVID, long COVID, persistent post-COVID): An integrative classification. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052621"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S0140-6736(20)32656-8","article-title":"6-month consequences of COVID-19 in patients discharged from hospital: A cohort study","volume":"397","author":"Huang","year":"2021","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s13365-021-00949-1","article-title":"Prevalence and correlates of chronic fatigue syndrome and post-traumatic stress disorder after the outbreak of the COVID-19","volume":"27","author":"Simani","year":"2021","journal-title":"J. Neurovirol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jama.2020.12603","article-title":"Persistent symptoms in patients after acute COVID-19","volume":"324","author":"Carfi","year":"2020","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/j.jaci.2020.12.641","article-title":"Clinical olfactory working group consensus statement on the treatment ofpostinfectious olfactory dysfunction","volume":"147","author":"Addison","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_28","first-page":"101","article-title":"Psychophysical evaluation of chemosensory functions 5 weeks after olfactory loss due to COVID-19: A prospective cohort study on 72 patients","volume":"278","author":"Pisarski","year":"2020","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_29","first-page":"378","article-title":"COVID19-ALC research Post-acute COVID-19 Syndrome","volume":"82","author":"Merino","year":"2021","journal-title":"Incidence and risk factors: A Mediterranean cohort study. J. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1002\/jmv.26465","article-title":"The \u201cpost-COVID\u201d syndrome: How deep is the damage?","volume":"93","author":"Garg","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e418","DOI":"10.3346\/jkms.2020.35.e418","article-title":"Three-month follow-up study of survivorsof Coronavirus Disease 2019 after discharge","volume":"35","author":"Liang","year":"2020","journal-title":"J. Korean Med. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Moldofsky, H., and Patcai, J. (2011). Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol., 11.","DOI":"10.1186\/1471-2377-11-37"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101995","DOI":"10.1016\/j.tmaid.2021.101995","article-title":"COVID-19 sequelae in adults aged less than 50 years: A systemic review","volume":"40","author":"Willi","year":"2021","journal-title":"Travel. Med. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1002\/jmv.26368","article-title":"Post-discharge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation","volume":"93","author":"Halpin","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1016\/j.jinf.2020.08.029","article-title":"Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19","volume":"81","author":"Garrigues","year":"2020","journal-title":"J. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Davis, H.E., Assaf, G.S., McCorkell, L., Wei, H., Low, R.J., Re\u2019em, Y., Redfield, S., Austin, J.P., and Akrami, A. (2021, May 07). Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. Available online: https:\/\/www.medrxiv.org\/content\/10.1101\/2020.12.24.20248802v2.","DOI":"10.2139\/ssrn.3820561"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e2036142","DOI":"10.1001\/jamanetworkopen.2020.36142","article-title":"Respiratory and psychophysical sequelae among patients withCOVID-19four months after hospital discharge","volume":"4","author":"Bellan","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"576","DOI":"10.7326\/M20-5661","article-title":"Sixty-day outcomes among patients hospitalized with COVID-19","volume":"174","author":"Chopra","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Saeed, S., Tadic, M., Larsen, T.H., Grassi, G., and Mancia, G. (2021). Coronavirus disease 2019 and cardiovascular complications; focused clinical review. J. Hypertens.","DOI":"10.1097\/HJH.0000000000002819"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1016\/j.hrthm.2020.06.026","article-title":"COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors","volume":"17","author":"Mitrani","year":"2020","journal-title":"Heart Rhythm."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Alemanno, F., Houdayer, E., Parma, A., Spina, A., Del Forno, A., Scatolini, A., Angelone, S., Brugliera, L., Tettamanti, A., and Beretta, L. (2021). COVID-19 cognitive deficits after respiratory assistance in the subacute phase: ACOVID-rehabilitation unit experience. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0246590"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"9302","DOI":"10.4081\/ejtm.2020.9302","article-title":"Coronavirus syndrome: COVID-19 psychotrauma","volume":"30","author":"Soloveva","year":"2021","journal-title":"Eur. J. Transl. Myol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Chang, M.C., and Park, D. (2020). Incidence of post-traumatic stress disorder after Coronavirus Disease. Health Care, 8.","DOI":"10.21203\/rs.3.rs-60070\/v1"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e240178","DOI":"10.1136\/bcr-2020-240178","article-title":"Late onset of Guillain-Barre syndrome following SARS-CoV-2 infection: Part of long COVID-19 syndrome?","volume":"14","author":"Raahimi","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.neurol.2020.04.003","article-title":"COVID-19 may induce Guillain-Barr\u00e9 syndrome","volume":"176","author":"Camdessanche","year":"2020","journal-title":"Rev. Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s13365-020-00941-1","article-title":"Opsoclonus-myoclonus syndrome, a post-infectious neurologic complication of COVID-19: Case series and review of literature","volume":"27","author":"Emamikhah","year":"2021","journal-title":"J. Neurovirol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"100094","DOI":"10.1016\/j.bbih.2020.100094","article-title":"Neurological involvement in SARS-CoV-2 infection: A clinical systematic review","volume":"5","author":"Scoppettuolo","year":"2020","journal-title":"Brain Behav. Immun. Health"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Shahali, H., Ghasemi, A., Farahani, R.H., Nezami Asl, A., and Hazrati, E. (2021). Acute transverse myelitis after SARS-CoV-2 infection: A rare complicated case of rapid onset paraplegia. J. Neurovirol., 1\u20135.","DOI":"10.1007\/s13365-021-00957-1"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Kilbertus, S. (2021). Acute transverse myelitis attributed to SARS-CoV-2 infection presenting as impaired mobility: A case report. CJEM, 1\u20132.","DOI":"10.1007\/s43678-021-00104-z"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40035-021-00237-2","article-title":"COVID-19 and Alzheimer\u2019s disease: How one crisis worsens the other","volume":"10","author":"Xia","year":"2021","journal-title":"Transl. Neurodegener."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Leta, V., Rodr\u00edguez-Violante, M., Abundes, A., Rukavina, K., Teo, J.T., Falup-Pecurariu, C., Irincu, L., Rota, S., Bhidayasiri, R., and Storch, A. (2021). Parkinson\u2019s disease and post-COVID-19 syndrome: The Parkinson\u2019s long-COVID spectrum. Mov. Disord.","DOI":"10.1002\/mds.28622"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e048391","DOI":"10.1136\/bmjopen-2020-048391","article-title":"Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: A prospective, community-based study","volume":"11","author":"Dennis","year":"2021","journal-title":"BMJ Open"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1080\/1744666X.2021.1847640","article-title":"Natural history of COVID-19 and the rapeutic options","volume":"16","author":"Gautret","year":"2020","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12929-020-00703-5","article-title":"Insights to SARS-CoV-2 life cycle, pathophysiology, and rationalized treatments that target COVID-19 clinical complications","volume":"28","author":"Trougakos","year":"2021","journal-title":"J. Biomed Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1002\/jmv.26610","article-title":"Pathogenesis-directed therapy of 2019 novel coronavirus disease","volume":"93","author":"Stratton","year":"2021","journal-title":"J. Med.Virol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"117271","DOI":"10.1016\/j.jns.2020.117271","article-title":"Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom","volume":"420","author":"Ortelli","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.biopsych.2011.11.018","article-title":"The stress-induced cytokine interleukin-6 decreases the inhibition\/excitation ratio in the rat temporal cortex via trans-signaling","volume":"71","author":"Salgado","year":"2012","journal-title":"Biol. Psychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"fcaa069","DOI":"10.1093\/braincomms\/fcaa069","article-title":"The cognitive consequences of the COVID-19 epidemic: Collateral damage?","volume":"2","author":"Ritchie","year":"2020","journal-title":"Brain Commun."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"110469","DOI":"10.1016\/j.mehy.2020.110469","article-title":"COVID-19 and chronic fatigue syndrome: Is the worst yet to come?","volume":"146","author":"Wostyn","year":"2021","journal-title":"Med. Hypotheses"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.7861\/clinmed.2020-0896","article-title":"Autonomic dysfunction in \u2019long COVID\u2019: Rationale, physiology and management strategies","volume":"21","author":"Dani","year":"2021","journal-title":"Clin. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3345","DOI":"10.1172\/JCI139642","article-title":"Preventing cytokine storm syndrome in COVID-19 using \u03b1-1 adenergic receptor antagonists","volume":"130","author":"Konig","year":"2020","journal-title":"J.Clin. Investig."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1111\/epi.16683","article-title":"Post-COVID-19 inflammatory syndrome manifesting as refractory status epilepticus","volume":"61","author":"Carroll","year":"2020","journal-title":"Epilepsia"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/qjmed\/hcaa255","article-title":"Post-COVID-19 pneumonia pulmonary fibrosis","volume":"113","author":"Tale","year":"2020","journal-title":"QJM"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Boumaza, A., Gay, L., Mezouar, S., Bestion, E., Diallo, A.B., Michel, M., Desnues, B., Raoult, D., La Scola, B., and Halfon, P. (2021). Monocytes and macrophages, targets of SARS-CoV-2: The clue for Covid-19 immunoparalysis. J. Infect. Dis., jiab044.","DOI":"10.1101\/2020.09.17.300996"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/s42255-021-00347-1","article-title":"SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas","volume":"3","author":"Muller","year":"2021","journal-title":"Nat. Metab."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Hayden, M.R. (2020). An immediate and long-term complication of COVID-19 may be type 2 diabetes mellitus: The central role of \u03b2-cell dysfunction, apoptosis and exploration of possible mechanisms. Cells, 9.","DOI":"10.3390\/cells9112475"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101204","DOI":"10.1016\/j.diabet.2020.10.002","article-title":"Potential metabolic and inflammatory pathways between COVID-19 and new-onset diabetes","volume":"47","author":"Sathish","year":"2021","journal-title":"Diabetes Metab."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jpeds.2020.08.003","article-title":"Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: A systemic review","volume":"226","author":"Abrams","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_69","first-page":"1450","article-title":"Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection-United Kingdom and United States, March\u2013August 2020","volume":"69","author":"Schwartz","year":"2020","journal-title":"Morbid\/Mortal. Wkly. Rep."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"100276","DOI":"10.1016\/j.ensci.2020.100276","article-title":"Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: A case report","volume":"21","author":"Novak","year":"2020","journal-title":"Eneurological Sci."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Nuzzo, D., Cambula, G., Bacile, I., Rizzo, M., Galia, M., Mangiapane, P., Picone, P., Giacomazza, D., and Scalisi, L. (2021). Long-term brain disorders in post Covid-19 neurological syndrome (PCNS) patient. Brain Sci., 11.","DOI":"10.3390\/brainsci11040454"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1111\/jth.15283","article-title":"Platelet-activating immune complexes identified in critically ill COVID-19 patients suspected of heparin-induced thrombocytopenia","volume":"19","author":"Nazy","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1111\/jth.15262","article-title":"COVID-19 patients often show high-titer non-platelet-activating anti-PF4\/heparin IgG antibodies","volume":"19","author":"Brodard","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e241059","DOI":"10.1136\/bcr-2020-241059","article-title":"Post COVID-19 sequelae: Venous thromboembolism complicated by lower GI bleed","volume":"14","author":"Kumar","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/jth.15267","article-title":"Prolonged elevation of D-dimer levels in convalescent COVID-19 patients is independent of the acute phase response","volume":"19","author":"Townsend","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Ladds, E., Rushforth, A., Wieringa, S., Taylor, S., Rayner, C., Husain, L., and Greenhalgh, T. (2020). Persistent symptoms after COVID-19: Qualitative study of 114 \u201clong COVID\u201d patients and draft quality principles for services. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-06001-y"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1016\/j.cmi.2020.07.028","article-title":"Post-COVID-19 chronic symptoms: A postinfectious entity?","volume":"26","author":"Davido","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_78","unstructured":"Washington Post (2021, May 07). Some Long-Haul COVID-19 Patients Say Their Symptoms are Subsiding after Getting Vaccines. Available online: https:\/\/www.washingtonpost.com\/health\/long-haul-covid-vaccine\/2021\/03\/16\/6effcb28-859e-11eb-82bc-e58213caa38e_story.html."},{"key":"ref_79","unstructured":"Medscape Pediatrics (2021, May 07). Some with Long COVID See Relief after Vaccination. Available online: https:\/\/www.medscape.com\/viewarticle\/947592."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/5\/497\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:59:42Z","timestamp":1760162382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/5\/497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,12]]},"references-count":79,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["vaccines9050497"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9050497","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,12]]}}}